| NPI | 1649542390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 1912048281) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IA 103t00000x) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |